| NPI | 1528262896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MT 2251) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MT 2251) |
| 1223G0001X Dentist, General Practice (Licence: MT 2251) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2024-10-25 |